<div class="parent-form">
<?php
echo $count;
echo $this->Html->css('jquery.password');
echo $this->Html->script('jquery.password');
?>
    <fieldset>
        <legend><?php echo __('Parent Info'); ?></legend>
        <?php
        echo $this->Form->input('User.'.$count.'.first_name');
        echo $this->Form->input('User.'.$count.'.middle_name');
        echo $this->Form->input('User.'.$count.'.last_name');
        echo $this->Form->input('User.'.$count.'.username', array('class' => 'username'));
        ?>
        <div class="feedback username-div"></div>
        <?php
        echo $this->Form->input('User.'.$count.'.password');
        echo $this->Form->input('User.'.$count.'.confirm_password', array('type' => 'password'));
        ?>
        <div class="feedback">
            <div id="strongy"></div>
            <div id="match"></div>
        </div>
       <?php
        echo $this->Form->input('User.'.$count.'.email', array('class' => 'email'));
        ?>
        <div class="feedback email-div"></div>
        <?php
        
        echo $this->Form->input('User.'.$count.'.dob', array('type' => 'date','label'=>'DOB'));
        echo $this->Form->input('User.'.$count.'.phone_1',array('class'=>'phone','label' => 'Primary Phone'));
        echo $this->Form->input('User.'.$count.'.phone_2',array('class'=>'phone','label' => 'Secondary Phone'));
        echo $this->Form->input('User.'.$count.'.marital_status_id');
        echo $this->Form->input('User.'.$count.'.alternate_contact', array('class' => 'alternate-contact','multiple'=>'checkbox','options'=>array('Post Mail'=>'Post Mail','Texting'=>'Texting')));
        ?>
        <div class="hidden alternat-info">
            <?php
            echo $this->Form->input('User.'.$count.'.alternate_phone',array('class'=>'phone'));
            echo $this->Form->input('User.'.$count.'.carrier_id',array('class'=>'phone'));
            ?>
        </div>
        <?php
        //echo $this->Form->input('ca_resident');
        echo $this->Form->input('User.'.$count.'.role_id', array('type' => 'hidden', 'value' => 2));
        echo $this->Form->input('User.'.$count.'.active', array('type' => 'hidden', 'value' => 1));
        //echo $this->Form->input('is_union_member', array('type' => 'hidden', 'value' => $_SESSION['is_union_member']));
        ?>
    </fieldset>
    <a href="#" onclick="return false;" class="remove-parent" >Remove</a>
</div>